Citi Bike For Business Enrollment Form
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Email *
Organization Name *
Check the box to confirm your subsidy amount. You must have more than 10 employees to join the program. *
Required
Address Line 1 *
Address Line 2
City *
State *
Zip Code *
County *
How many employees does your organization have in New York?   *
Program Manager Contact Information
This person is the primary contact for the account and will receive automatic email notifications when new members enroll under your company's program.
Program Manager Name *
Program Manager Job Title *
Program Manager E-mail *
Program Manager Direct Phone *
Secondary Contact Information
Optional: This person is the secondary contact for the account and will also receive automatic email notifications when people enroll under your program.
Secondary Contact Name
Secondary Contact Job Title
Secondary Contact E-mail
Secondary Contact Direct Phone
Accounts Payable Contact Information
This person receives monthly invoices.
Accounts Payable Name *
Accounts Payable Job Title *
Accounts Payable Email *
Accounts Payable Direct Phone *
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